Dietary Patterns and the Risk of Dyslipidemia in Korean Adults A Prospective Cohort Study Based on the Health Examinees (HEXA) Study

Background Identifying dietary patterns that contribute to dyslipidemia development can inform prevention, nutritional counseling, and other treatment recommendations. Objective This study aimed to identify major dietary patterns and examine the association between these dietary patterns and dyslipidemia incidence by sex among Koreans. Design The Health Examinees (HEXA) study is a community-based prospective cohort study. The baseline and follow-up surveys were conducted in 2004-2013, and 20122016, respectively, at 38 health examination centers and training hospitals located in eight regions in Korea. Dietary intake data were collected using a web-based, validated semiquantitative food frequency questionnaire (FFQ) at baseline. Participants/setting Among 65,642 participants who completed the baseline and follow-up survey, data from 38,170 participants without dyslipidemia and other related chronic diseases at baseline were analyzed. Main outcome measures Incidence of dyslipidemia and its components (hypercholesterolemia, hyper-low-density lipoprotein [LDL] cholesterolemia, hypo-high-density lipoprotein [HDL] cholesterolemia, and hypertriglyceridemia) after baseline but before the follow-up examination was examined. Statistical analyses Factor analysis was conducted on data from the semiquantitative FFQ to identify major dietary patterns for Korean adults. Cox proportional hazards regression analysis was performed to estimate the relative risk (RR) and 95% confidence interval (CI) according to the quintiles of three dietary pattern scores, after adjusting for potential confounders by sex. Results Of the three identified dietary patterns, the higher "prudent" pattern score was associated with a lower incidence of dyslipidemia (RR, 0.90; 95% CI, 0.82-0.99; P = .02) after adjusting for potential confounders in women. Higher "flour-based food and meats" pattern score was associated with a higher incidence of hypercholesterolemia (men: RR, 1.63; 95% CI, 1.21-2.20; P = .003; women: RR, 1.47; 95% CI, 1.30-1.67; P < .001), hyper-LDL cholesterolemia (men: RR, 1.45; 95% CI, 1.03-2.04, P = .06; women: RR, 1.35; 95% CI, 1.161.58, P < .001), and dyslipidemia (men: RR, 1.30; 95% CI, 1.09-1.54; P = .009; women: RR, 1.28; 95% CI, 1.16-1.42; P < .001) in both men and women. The "white rice" pattern score was associated with a lower incidence of hypo-HDL cholesterolemia (RR, 0.75; 95% CI, 0.58-0.96; P = .01) and dyslipidemia (RR, 0.90; 95% CI, 0.81-0.99; P = .07) in women. Conclusions Adherence to the "prudent" and "white rice" patterns was associated with a lower dyslipidemia risk in Korean women, whereas adherence to the "flour-based food and meats" pattern was associated with increased risks of dyslipidemia and its components (hypercholesterolemia and hyper-LDL cholesterolemia) in both Korean men and women. J Acad Nutr Diet. 2021;121(7):1242-1257.